Your Rights in a Nursing Home

What are your rights as a Resident of a Nursing Home.   Most people start their journey in a nursing home setting via an admission after a hospital stay for short term (subacute) rehab.  Form here, people go home on their own, need ongoing care once the go home or due to a significant change in care needs, decide to stay long term in a nursing home.

Here are some tips you should be aware of:

  • A person must have a 3 days hospital admission prior to transfer to short term rehab. If this criterion is not met, Medicare will not cover rehab AT ALL.  Sometimes people spend a few days in the hospital under “observation” but are never admitted.  It is critical that you understand the admission status at hospital
  • Medicare only covers 20 days at 100%. IF the supplemental insurance does not cover the copay of $170.50 per day, you will be responsible from day 21 forward.  Therefore, you must know your supplemental coverage limitations up front.
  • You do not get 100 days automatically under Medicare. You must continue to meet the coverage requirements such as continued improvement in Physical therapy.  When the “Skilled need” ends – as determined by the facility – you can appeal.  Ultimately, your coverage can end at any point.  If you do not leave by the time the coverage ends, you will have to pay the full daily rate to stay.
  • Start to think about and plan for discharge upon admission. Your stay can end with very short notice.  If you have not considered the options for necessary long-term care Post-rehab, you will be scurrying at the last minute.
  • If the facility says you are ready for discharge, but you do not have a safe and adequate plan to return home, they CANNOT send you home if there is no safe plan for discharge. They cannot force a family member to take on care if they are not willing.  However, they can start to charge you privately if you do not qualify for Medicaid
  • If you are staying past the date of your insurance coverage, and you are eligible and plan to apply for Medicaid, they cannot force you to give them private pay funds pending Medicaid.
  • Most Nursing Homes no longer file Medicaid applications in-house. They will connect you with a private company or an elder law attorney to help you to file for Medicaid.  There is almost always a fee based service. If you cannot afford to pay, the facility really should help you to file free of cost.
  • If you have any assets above the Medicaid limit of $15,450 when you begin to consider a long-term nursing home placement, you should be speaking with a Medicaid specialist. They can help to determine if there are any strategies you can employ to protect the assets.  Some Medicaid and/or senior planning companies are just filing paperwork but do offer strategies. This may include options for returning home or just to protect the assets once there is a permanent placement.  There ARE strategies to protect assets at the last minute when someone is admitted for a long term stay in a nursing home as well as strategies on filing if the stay is extended but not permanent.  So seek out a Medicaid Specialist or Elder Law Attorney that will do more than just file for Medicaid.

 

If you have any concerns or are unsure of you rights regarding discharge planning or finances, consider reaching out to a Medicaid specialist.   However, you can always connect with your facilities ombudsman (855-582-6769) or file a complaint with the New York State Department of health (888-201-4563) or obtain a compliant form online via  https://apps.health.ny.gov/nursing_homes/complaint_form/complain.actionb

 

Colin SandlerContributor: Colin Sandler

Providing Advice for Aging. Assistance with long term planning, community resources, medicaid eligibility and filing as well as pooled income trusts.

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